SHM Converge Scientific Abstract ePoster Gallery-A Case of Anti-Nmda Receptor Encephalitis Needing Multiple Treatment Options

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This case describes a 32-year-old woman with anti-NMDA receptor encephalitis, a severe autoimmune brain disease caused by IgG antibodies against the NR1 subunit of the NMDA receptor. The illness can present with a broad mix of psychiatric and neurologic symptoms, including seizures, confusion, hallucinations, catatonia, dyskinesias, and autonomic instability. Prodromal viral or gastrointestinal symptoms may occur, and diagnosis is often supported by CSF inflammation, NMDA receptor antibodies, and sometimes normal brain MRI findings.<br /><br />The patient initially presented after a seizure with confusion and recurrent tonic-clonic activity. Early workup showed an unremarkable head CT and brain MRI, but lumbar puncture revealed lymphocytic pleocytosis. CSF later confirmed strongly elevated NMDA receptor antibodies, prompting treatment for autoimmune encephalitis.<br /><br />Her hospital course was prolonged and refractory. She was treated sequentially with high-dose steroids and plasma exchange, followed by IVIG. Imaging identified bilateral ovarian masses, and she underwent bilateral salpingo-oophorectomy; pathology showed bilateral teratomas, supporting a paraneoplastic cause. Despite tumor removal and first-line therapy, she had minimal improvement, so second- and third-line immunotherapies were added, including rituximab, cyclophosphamide, and later bortezomib. Supportive symptom-directed treatments were also attempted, including ECT, amantadine for catatonia/encephalopathy, and tramadol for dyskinesias.<br /><br />During continued evaluation, PET imaging revealed a left thyroid nodule, and biopsy confirmed papillary thyroid carcinoma, leading to total thyroidectomy. After weeks of intensive multimodal treatment, the patient slowly improved and was eventually discharged after more than three months in the hospital.<br /><br />Overall, the case highlights the complexity of anti-NMDA receptor encephalitis and the need for combined immunotherapy, tumor removal when present, and aggressive symptomatic management.

Asset Subtitle

Mithun R. Suresh

Meta Tag

Author List Mithun R. Suresh

Category Clinical Vignettes

Concept Anti-NMDA Receptor Encephalitis

Concept Immunotherapy

Concept Tumor Screening

Concept Tumor Resection

Concept Ovarian Teratoma

Distinguished Non-Finalist

Presenter Organization CentraCare

Presenting Author Mithun R. Suresh

Track Adult

Keywords

anti-NMDA receptor encephalitis

autoimmune encephalitis

NR1 subunit

CSF pleocytosis

seizures

ovarian teratoma

paraneoplastic syndrome

rituximab

bortezomib

papillary thyroid carcinoma

Anti-NMDA Receptor Encephalitis

Immunotherapy

Tumor Screening

Tumor Resection

Ovarian Teratoma